A systematic review summarises published evidence on the association between early sexual debut and women’s risk of HIV infection in sub-Saharan Africa.

Early sexual debut may increase women’s risk of HIV infection in four different ways. Women who started sex early:

have a longer duration of sexual activity and are therefore potentially exposed to HIV infection risk for a longer period of time

are more prone to engage in risky sexual behaviours such as high numbers of sexual partners (including premarital, casual partners or sex partners through transactional sex), as well as lower rates of contraceptive and condom use

are more susceptible to HIV infection due to the physiological and immunological immaturity of their reproductive tract

more likely to have partners who are at higher HIV risk, because these men are often older, or because they are more likely to have multiple sexual partnerships or engage in heavy drinking

The paper concludes that:

higher quality studies consistently found significant associations between early sexual debut and HIV, which remained after social-demographic factors were controlled for

HIV risk may be increased at first sex because of genital trauma and/or because the partner may be more likely to be HIV infected

forced first-sex may be an important explanatory factor for subsequent patterns of high risk behaviours

The review illustrates the need for further evidence, including additional research to better understand the determinants and implications of early sexual debut for women and the links with HIV risk, and to identify areas amenable to intervention.

There is a fine line between trying to protect girls’ health by delaying sexual debut and restricting sexuality through unresponsive ‘abstinence-only’ policies.